Provider Demographics
NPI:1841352895
Name:KELLY, PAUL EDWARD (MENTAL HEALTH CLINIC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:EDWARD
Last Name:KELLY
Suffix:
Gender:M
Credentials:MENTAL HEALTH CLINIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3698 SEABASS RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-6954
Mailing Address - Country:US
Mailing Address - Phone:404-244-8836
Mailing Address - Fax:404-244-9611
Practice Address - Street 1:3698 SEABASS RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-6954
Practice Address - Country:US
Practice Address - Phone:404-244-8836
Practice Address - Fax:404-244-9611
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health